Silver sutures in surgery : the anniversary discourse before the New York Academy of Medicine, delivered in the new building of the Historical Society on November 18, 1857

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SILVER SUTURES IN SURGERY.

T II E

ANNIVERSARY DISCOURSE,

ORE THE

NEW YORK ACADEMY OF MEDICINE.

DELIVERED IN THE NEW BUILDING OF THE HISTORICAL

SOCIETY, OX THE 18th NOVEMBER, 1867.

BY

J. MARION SIMS, M.D.,

SURGEON TO THE WOMAN'S II O S V I T A L

(published by order of the academy.)

55

NEW YORK:

SAMUEL S. & WILLIAM WOOD,
1189 BROADWAY.

1858.

<

SILVER SUTURES IN SURGERY.

THE

ANNIVERSARY DISCOURSE

BEFOEE THE

NEW YORK ACADEMY OF MEDICINE.

DELIVERED IN THE NEW BUILDING OF THE HISTORICAL
SOCIETY, ON THE 18th NOVEMBER, 1857.

BY

J. MARION SIMS, M.D.,

SUKGEON TO THE WOMAN'S HOSPITAL.

(PUBLISHED BY ORDER OF THE ACADEMY.)

09

NEW YORK:

SAMUEL S. & WILLIAM WOOD,
389 BROADWAY.

1858.

/8

JOHN F. TROW,

Printer and Stereotyper.

8T7 & 379 Broadway N. Y.

NEWYORK ACADEMY OF MEDICINE.

»♦»

A special meeting of the Academy was held at the
new building of the Historical Society, corner of Second
Avenue and Eleventh Street, on the 18th of November,
1857 — Dr. Mott, President, in the chair.

The reading of the minutes of the previous meeting
was dispensed with, when Dr. J. Marion Sims delivered
the Anniversary Oration, being a paper on Silver Su-
tures in Surgery.

At its conclusion, on motion of Dr. John W. Francis,
seconded by Dr. Beadle, the thanks of the Academy
were presented to the Orator.

Dr. Smith then offered the following resolution :

Resolved, That a committee of three be appointed to wait upon
Dr. Sims, and request a copy for publication.

Whereupon Drs. John W. Francis, Joseph M. Smith,
and John Watson were appointed said Committee.

C. F. Heywood, M.D.,

Recording Secretary.

In consequence of the length of this Discourse, parts
of it were omitted at the Anniversary Meeting. Most
of the illustrations accompanying it are from original
drawings, by Dr. Thomas Addis Emmet, the accomplished
Assistant Surgeon to the Woman's Hospital.

J. M. S.

ANNIVERSARY DISCOURSE.

♦♦♦-

Mr. President, and Fellows of the Academy of Medicine.

On this happy return of another Anniversary,
it must be a source of congratulation with every
well-wisher of this Academy, to see here on the
platform with our distinguished President, (Dr.
Mott,) so many of the eminent men, who, like
him, have at various times ably filled the same high
position.

The presence of our honored ex-presidents,
John W. Francis, Alexander H. Stevens, Thomas
Cock, Isaac Wood, Joseph Mather Smith, and Wil-
lard Parker, lends additional grace, dignity, and in-
terest to the occasion, well worthy of permanent
historic remembrance. Long may they live to re-
joice at the prosperity of this Academy, and to shed
the lustre of their great names upon its labors.

6 SILVER SUTURES.

This presidential galaxy, too, is naturally
suggestive of the names of those who have filled
the less important post of Orator. Ten years ago
that venerable Nestor of the profession, the devoted
and eloquent Francis, inaugurated your anniversa-
ries by a characteristic oration, replete with learning,
anecdote, and historic incident, before an unprece-
dented audience of more than four thousand spell-
bound hearers, while thousands left unable to gain
admittance. This mighty effort of the great and
good man gave the community a just estimate of
the value and importance of this learned body,
which, it is to be hoped, we shall ever maintain.
He was followed by the late lamented Manly.
Then came the truthful and lucid Post ; and next,
the learned and critical Joseph M. Smith. After
him, the elegant and accomplished F. Campbell
Stewart ; then the eminent, exact, and public spir-
ited Griscom ; and last, though not least, your
own classic Watson.

Is it then a matter of surprise that I have mani-
fested so much diffidence in following the footsteps
of these distinguished men ? Apologies on such
occasions, are too frequently affected, but were I
to proceed without some explanation, I should do
injustice to you, and great violence to my own sense
of propriety. When a member of this Academy
but little more than one year, you conferred upon

SUBJECT OF DISCOURSE. 7

me this distinguished honor; electing me in my
absence, and without my knowledge or consent, —
a compliment that I appreciate with all my heart ;
but a consciousness of my unfitness for the place
prompted me at once to resign ; when such men as
Mott, Francis, Stevens, Smith, Green, Griscom,
White, and others opposed my withdrawal, agree-
ing, (unofficially,) that my subject should be purely
a professional one.

Silver Sutures in Surgery, is a subject that
necessarily involves frequent and constant reference
to my oWn labors, and their results ; indeed, it has
been the theme of my life for the last twelve years.
In selecting it I am not ignorant of the delicacy of
my position, and of my liability to be misinterpreted,
and to be criticised by some who do not know me
as you do. Nevertheless I shall speak as an Amer-
ican, plainly, frankly and fearlessly, feeling that you
and the great mass of the profession will understand,
and fully sustain me. So far as it concerns my ex-
perience, personal narrative, claims as a discoverer,
or defence against aggression, I have a right to de-
clare them openly u from the house-tops; " and for
this in the abstract I hold myself responsible. But,
whether the subject matter will be considered quite
appropriate for the occasion, is a question only for
the fastidiously censorious ; and I shall dismiss that
very summarily, by shifting its responsibility to the

4

**

8 SILVER SUTURES.

broad shoulders of the gentlemen just named, at
whose solicitation I stand here to-night.

You, who are familiar with the experience of
that noble charity, the Woman's Hospital, will not
be surprised, when I declare it as my honest and
heart-felt conviction, that the use of silver as a su-
ture IS THE GREAT SURGICAL ACHIEVEMENT OF THE
NINETEENTH CENTURY.

For my country I claim the honor of this imper-
ishable discovery, and seize this auspicious occasion
to place permanently upon record a history of its
origin and progress.

Many of you already know that it was not the
result of mere accident, but of long, laborious and
persevering effort, based upon the immutable princi-
ples of science, and forming one of the most beau-
tiful examples of inductive philosophy.

Wishing to impress upon the profession its
importance and value in general surgery, as well as
in injuries from protracted parturition, I shall ne-
cessarily be compelled to draw largely and some-
what minutely upon my past experience. But this
will be readily tolerated by a liberal profession ; for,
while I labor to establish principles, it will be legit-
imate to refer to dates, and times, and places, and
persons, and circumstances, all of which are necessary
to place for ever beyond cavil my claims and agency
in this discovery.

WHEN FIRST USED. 9

In 1845 I conceived the idea of curing vesico-
vaginal fistula, and entered upon the broad field
of experiment with all the ardor and enthusiasm
of a devotee. After nearly four years of fruitless
labor, silver wire was fortunately substituted for silk
as a suture, and lo ! a new era dawns upon surgery.

This was on the 21st of June, 1849, since which
time I have used no other suture in any depart-
ment of surgery.

The American Journal of Medical Sciences for
January, 1852, contains my article on "The Treat-
ment of Vesico-vaginal Fistula," with full and speci-
fic directions for every stage of the operation. The
silver suture, as then used, I called the "clamp
suture," on account of its method of action in forc-
ing, or " clamping " firmly together the surfaces to be
united. Merely for its historical value, and to show
the progress of improvement, it is here introduced.

Fig. 1, represents the anterior wall of the vagina,
the posterior being cut up and laid open, thus
exposing the fistula closed by the clamp suture.

By perforated shot compressed upon the silver
wires, they are secured to leaden cross-bars or
u clamps," which burrow in the vaginal tissue; the
whole remaining till union by the first intention be-
comes firm, when, by clipping off the shots the
sutures are removed.

In my own hands this method of using

10

SILVER SUTURES.

Fig. 1.

the silver wire in
vesicovaginal fistu-
la was uniformly suc-
cessful, because I al-
ways took good care
to make a broad and
free scarification of
the edges of the fis-
tula, and to pass the
sutures so far from
them that the cross-
bars or clamps would
burrow in the vagi-
nal tissue, there to remain till the case was permanent-
ly cured. But my followers were not so successful,
simply because these two important points were not
fully appreciated. They complained that the sutures
would cut out ; a thing that never happened with me
in but three or four cases, and they were amongst
my first experiments, before learning thoroughly
the art of applying them.

The city of Montgomery, Alabama, was the the-
atre of my early operations. Bad health compelled
me to leave there in 1853. I then gave Dr.
Bozeman of that place a partnership in business, and
indoctrinated him in my peculiar method of operat-
ing for vesico-vaginal fistula, instructing him in my
various modes of using silver wire as a suture, not

EFFORTS TO SUPPLANT AUTHOR. 11

only in this class of affections, but in general sur-
gery. Not understanding its principle of action,
and therefore failing in its practical application, he
was quite disheartened with his ill success, when by
mere accident he fell upon a plan of fastening the
wire, and so modifying my method, that in awkward
or inexperienced hands it
became easier of applica-
tion. Instead of passing
the wires through the
leaden bars on each side
of the fistula, he passed Fi °- 2 -

them through a concave disk or u button" which
rests upon the surface of the parts to be united, as
shown by fig. 2.

Notwithstanding the fact that the doctor lived in
Montgomery for years, without any professional posi-
tion till I gave it to him, that he is indebted to
me for what he could never have obtained without
my aid, he appropriates to himself every step of
the operation that resulted from my own indivi-
dual and unaided efforts, — even my silver wire and
perforated shot, the only things of any real value
whatever, and publishes it as his operation by a
u new mode of suture," making strenuous efforts to
place my labors entirely in the background.

I do not complain of modifications, but I do

12 SILVER SUTURES.

complain of a disingenuousness that would be dishon-
orable even under widely different circumstances.

While I know that posterity will do me full jus-
tice, I do not even fear the verdict of my contempo-
raries, when the whole of the facts and their
philosophy are laid plainly before a just and discrimi-
nating profession. But, Sir, if you wish to offer a pre-
mium for the encouragement of secret remedies, rob
me of my well earned claims, as the discoverer and
propagator of a great principle that shall live as
long as surgery is cultivated as a science, or practised
as an art; — and, if you are particularly desirous
to drive your young men ambitious of honorable
distinction, from their high resolves to elevate and
ennoble our calling, show them that you are ever
ready to thus endorse any attempt to detract from
the meed of their self-sacrificing efforts.

An honorable sensitiveness on the score of pro-
fessional claims and personal rights is natural, and
comes home to every man, whether his reputation
be already established, or merely prospective. — And
no one, Mr. President, is more capable of fully
appreciating this than your honored self, whose
brilliant surgical achievements have so often been the
object of envy and detraction.

But to the facts and their analysis : — Dr. B.'s
paper "on vesico-vaginal fistula, by a new mode of
suture," was published in the first No. of the Louis-

EXPERIMENTS AT WOMAN S HOSPITAL.

13

ville Review, for May, 1856. He there labors to show
that nothing comparatively had been done for this
injury till the use of his button, while with it, there
could be no such thing as a failure. Although I
knew very well why he failed with the clamp, still I
was determined to see what advantage the button
possessed over it, if any.

Having at the Woman's Hospital an ample field
for experimental observation, I lost no time in test-
ing his modification of my suture ; and as my ex-
periments were valuable in establishing a principle,
I shall give a brief detail of them.

Case T. — The
fistula was trans-
verse,inthemedian
line, about an inch
above the neck of
the bladder, with
abundant tissue,
and every thing
favorable for an
easy and success-
ful operation. The
wires were passed
as usual with me,
brought through
the u button," and fastened with the perforated

Fig. 8.

14 SILVER SUTURES.

shot. They were removed on the ninth day, leaving
two small fistulous openings in the line of union,
thus showing a failure of the " button/' greatly to
my surprise, for I could not imagine a better case for

success. Fig. 4, a &, the
line of cicatrized union,
c c?, the two little fistu-
las left in its track.

Fig. 4.

Case II. — Aged 57. A sister to the above, with a
similar fistula, but a little nearer to the neck of the
bladder. Sexual organs normally atrophied, as
usual with women at her time of life. Operation
on the same day, and in the same manner as Case I,
and with a like unfortunate result; for when the
sutures were removed on the ninth day, there was
a small fistulous opening at the extreme end of the
new cicatrix on the right side.

Case III. — Aged 37. A fistula extended
from the meatus urinarius through the urethra
and neck of the bladder, laying the septum open,
to within f of an inch of the cervix uteri. I
had closed the whole of this fistulous track by a
previous operation, except a small point in the has
fond of the bladder, which had been purposely-
left open for a catheter during the time the su-
tures were applied to the injured part below;

EXPERIMENTS AT WOMAN IS HOSPITAL.

15

and now it only remained to close up this small
fistula thus so favorably situated. The wires, (two,)
were passed transversely and secured by the button.

Fig. 5.

Fig. 5 shows the little fistula a, above described.
The operation was similar to the two preceding, and
had a like unfavorable result ; an opening half the size
of the former was left. Thus three very favorable
cases for the clamp, had failed by the "button' of
Dr. B.

Before this result was known I had applied
it in four other cases, three of them unfavorable,
and where I had not succeeded with the silver
suture after my usual method by the " clamp.' 1

Case IV. is one in which I had united the
anterior and posterior walls of the vagina about an

16

SILVER SUTURES.

inch above the urethra, leaving a small fistula not
larger than the point of a common probe.

Fig. 6, shows the cervix uteri and the vesico-
vaginal septum destroyed by the sloughing process.
To convert the upper part of the vagina and the

Fig. 6.

bladder into one common receptacle, the posterior
wall of the vagina, at c, had been united by the wire
and clamps to the anterior at a, leaving a small
opening not larger than a No. 7, sewing needle. To
this the button was applied, and failed.

Case V. was similar, with a greater loss of sub-
stance. There was but a small part of the neck of
the bladder attached to the urethra.

The mouth of the vagina had been closed by
uniting its posterior wall to the urethra just as they
lay naturally in contact, leaving two little fistulse
not larger than a common-sized probe, one at each
extremity of the line of union. I had failed to

EXPERIMENTS AT WOMAN'S HOSPITAL. 17

close these by the silver wires, secured by the
clamps or leaden bars, and now applied them with
the button. The operation in both instances failed.

Case VI.-A small fis-
tula a, fig. 7, at the neck J ^ -^ ||

of the bladder; tissue II
scanty and indurated ; w W

button failed, [a, &, line ^8^7 ^— ~~^mf ?

of union effected by a ^BJy ^

distinguished surgeon Fig - 7 -

before her admission to the Woman's Hospital.]

Case VII. — Here the injury was at the neck of
the bladder, (see fig. 9,) ; — The button was used,
and union took place.

Six successive failures * out of seven operations
with the silver suture, secured by Dr. B.'s method,
was a most astonishing result ; and it was but natu-
ral to inquire into the cause. I had supposed that
his success was due to the button, which was not
the case, as the sequel will show.

Anxious to test fairly the advantages of this
plan of securing the silver wires, I had performed
these seven operations in as many days, and the last
one was executed before the result in any preceding
case was known.

* Subsequently cured by the silver wire, as a simple interrupted suture.

Since the above was written, Dr. B. has published cases in which his

button failed repeatedly in his own hands.

2

18

SILVER SUTURES.

In the first six operations the wires were passed
precisely as I do when they are to be fastened by
leaden bars and perforated shot, and they all fail-
ed; thus establishing the fact, that the principle
in their application essential to success with the

/

J

Fig. 8.

clamps, was the one to produce a failure by the
button ; and vice versa, the principle of success by
the button was that of failure by the clamp.

Let me explain —

If the clamps or leaden bars are to be used to
secure the wires, the sutures must be passed as
shown at 6, fig. 8, so far from the edges of the
fistula as to allow the bars to sink down into the

PHILOSOPHY OF THEIR APPLICATION. 19

vaginal structure, making it utterly impossible for
them to cut out. But if the disk or button is to be
used, then the sutures are to be passed very near,
it matters not how near, the edge of the fistula, as
at a.

Now if the clamps are used with the sutures
passed as at a, they will invariably cut out, because
there is not space enough for them to burrow ;
whereas, if the button is used with the wires passed
as at b, the effort necessary to draw the parts up
into its concavity will inevitably roll over, and force
together the undenuded surfaces between the edges
of the scarification and the entrance of the wires,
which will to some extent invert the fistulous edges
proper, while the traction by the button will cause
the sutures to cut through, as at c and d, fig. 4.

Thus it is clearly seen why my followers failed
with the clamp, and why I failed so signally with
the button.

Fig. 9, is intended to show the relations of the
fistula in the seventh case, which was the only suc-
cessful one of the series. It was just at the neck of
the bladder, the tissue was deficient, and the edges
inverted, or turned towards the pubic arch. Here
the sutures were passed close to the edges of the
fistula, as shown in the figure ; but when the but-
ton was to be applied, I found that it had to be
convex instead of concave, as so particularly recom-

20

SILVER SUTURES.

mended by Dr. B. Notwithstanding this, union
took place. If the button had been made with a

Fig. 9.

concavity, and thus applied, forcing the edges of
the fistula up into it whether or not, the wires
would have cut out before union could have been
effected.

These cases demonstrated very clearly to my
own mind that Dr. B. had mistaken the philosophy
of the suture. He attributed its success in his
hands to the button or disk, whereas this is wholly
an unnecessary addendum. The truth is, that the
great success of these operations is due entirely to

INTERRUPTED SUTURE SUFFICIENT. 21

the silver wire. I had long ago demonstrated, over
and over again, that the clamps or leaden bars and
perforated shot were totally worthless, if used with
silk as a suture ; in other words, that the silver wire
was the essential part, the sine qua non of success ;
and I had now seen that the button, to which so
much importance was attached, had failed in six
successive cases, while it succeeded in the seventh
when it no longer possessed the peculiar character-
istic thought to be essential to success. Seeing
thus that the much vaunted button was obnoxious
in some cases, and nugatory in others, I now began a
series of experiments with the wire as an interrupted
suture, without u clamps" or " buttons" so called.

Past experience had shown me, that as an inter-
rupted suture, it was alone sufficient in general sur-
gery : and there was no good reason why it should
not prove equally as effective in the injuries result-
ing from tedious labor. It was accordingly applied
in the following case on the 24th of June, 1856.

Ellen, aged 30, had been the subject of repeated
operations in various hospitals, when at last she fell
into the hands of Dr. B. Fordyce Barker, the able
Professor of Obstetrics in the New York Medical
College, who sent her to the Woman's Hospital.

The fistula was very large, extending from the
cervix uteri down to the neck of the bladder, and

22

SILVER SUTURES.

involving the loss of nearly half of the vesical septum.
A large mass of inflamed and hypertrophied mucous

Fig. 10.

membrane from the cavity of the bladder protruded
through it into the vagina, often becoming strangu-
lated, and producing the most intense suffering.

Fig. 10 shows its relations. After proper scari-
fication, seven interrupted silver sutures were pass-
ed transversely and fastened, each separately, by a
perforated shot. On the 8th day they were re-
moved. The cure was perfect.

THEIR APPLICATION. 23

This case with all its difficulties satisfied me that
the silver wire was all sufficient here, as I had
long known it to be in other departments of surge-
ry ; and I applied it with the same unvarying suc-
cess in other cases, dispensing with all unnecessary
addenda, even the perforated shot ; simply tying or
twisting the wire.

The wire must be made of virgin silver, an-
nealed, and small enough for a suture.* In some
cases the needle may be armed with it, and so used ;
but in the majority of operations about the vagina,
I prefer to pass silk ligatures first, and with these to
draw the wires after. The sutures should be passed
in, near the edge of the fistula, as at fig. 9, page 20,
taking care to embrace the whole denuded surface,
but not to penetrate the mucous lining of the blad-
der. They should, as a general rule, be about T 3 T of
an inch apart, and each tied separately, by twisting
the two ends of the wire together, then cutting
them off, and leaving the twisted ends at least half
an inch long, to facilitate their removal. (See figs.
11, and 12.)

Fig. 11, shows the method of twisting the wire.
Two sutures are represented as secured and cut off,
with the twisted ends bent flatly down on the sur-

* Mr. Berenbroick, No. 83 Duane street, makes two sizes for me, No. 28
and 29, the last being the finest and most used.

24

SILVER SUTURES.

Fig. 11.

face, while the third is undergoing the process of

torsion.

The fulcrum of support is held firmly in the left
hand, while a pair of forceps in the right makes

THEIR REMOVAL.

25

steady traction on the wire doubled on itself, when
by a rotary movement of the forceps the wire is
quickly and evenly twisted, thus looping firmly
together the edges already nicely co-apted.

Fig. 12.

26 SILVER SUTURES.

It is unnecessary to allow the wires to remain
longer than the 8th day. To remove them, take hold
of the twisted end with a long delicate pair of for-
ceps, fig. 12, pull it gently out, till the loop which was
buried in the tissue becomes visible ; slip the blade
of a sharp-pointed pair of scissors within it,
and clip the wire. Then it is easily re-
moved, straightening out and assuming the
form of fig. 13. Some care is needed to cut
the wire in the loop instead of the twist.
Fig . 13 . It may not be amiss here to say, that

beside this simplification of the suture, my position
at the Woman's Hospital has afforded me facilities for
making other improvements in this operation since
my first publication in 1852 ; for instance, the spec-
ulum, fig. 14, is altered to give a greater leverage : the
handle curves back at about an angle of 30° instead
of being at right angles with the blade, having a
counter curve in the middle, while another blade
of a different size mounts the other extremity.
This arrangement gives the assistant great power in
drawing the perineum back towards the os coccygis.
I formerly used a needle with a long shaft, but
a visit to New York some three or four months
after the publication of my paper, (January, 1852,)
enabled me to have some short needles and a
needle-holder made by Tieman, which among other
things have been appropriated by the writer in

AUTHOR S SPECULUM.

27

the Louisville Medical Review before alluded to;
but I now prefer a simple pair of forceps with

,

Fig. 14.

serrated jaws, properly adapted to the needle as

seen in fig. 15.

The catheter is also improved so as to project

28

SILVER SUTURES.

Fig. 15.

beyond the vulva, and drop the urine in a cup, thus
protecting the person and bedding.

Another improvement is in allowing a more

AUTHOR S SELF-RETAINING CATHETER.

29

liberal diet than formerly, but still constipating by
anodynes and the recumbent posture.

Fig. 16.

But the most useful of all these improvements
is in the position of the patient during the opera-
tion. A few require to be placed on the knees with
the head and thorax depressed, as I formerly did,
and as my followers do still ; but in the great
majority of cases, the patient may lie on the left
side, while the operation will be executed with equal
facility to the surgeon, and, of course, with more
ease to the patient.

30

SILVER SUTURES.

In this position the thighs are to be flexed at
about right angles with the pelvis, the right a little
more than the left. The left arm is thrown behind,
and the chest rotated forwards, bringing the ster-

Fig. IT.

num quite closely in contact with the table, while

IN LACERATED PERINEUM. 31

the spine is fully extended, with the head resting
on the parietal bone.

The patient being thus rolled over as much as
possible on the front, the assistant standing at her
back, elevates with the left hand the right side of
the nates, while the right holds the speculum which
draws up the perineum, allowing the pressure of
the atmosphere to dilate the vagina so as to bring
every part of it into view. This position permits
the use of anaesthetics if desired, but I never resort
to them in these operations, because they are not
painful enough to justify the trouble, and risk attend-
ing their administration.

Having thus digressed for a few moments to
speak of these improvements, for which we are
indebted to that prolific field of observation, the
Woman's Hospital, I recur again to the proper
theme.

Previously to the experiments already detailed,
I had used silver sutures with the leaden bars
or clamps in all operations about the vagina, and
perineum, and had every reason to be perfectly
satisfied with the results ; but seeing now that
the simple interrupted silver suture was sufficient
in the most difficult cases of vesico-vaginal fistula,
I lost no time in extending its use to lacerations
of the perineum, and found it here quite as effec-

32 SILVER SUTURES.

tual ; hence I adopted it in all such cases, not
because it is more efficacious, but because it is sim-
pler in its application, and quite as certain in its
results. And in no instance of lacerated perineum,
it matters not how extensive, have I ever resorted
to a division of the sphincter ani, which, (with the
silver suture,) is a horrible and wholly unnecessary
complication.

It is strange that the Profession have been so
slow in adopting this suture. From the day its
wonderful effects were witnessed in vesico-vaginal
fistula in 1849, I have never used any other suture
in any department of surgery.

Wishing to impress upon the Profession its great
value in general surgery, and at the same time, to
render permanently historic my claims to priority,
I propose to show what it has already done, as
contrasted with the usual methods. Hence some
little detail of facts, and dates.

In plastic surgery it is the great desideratum.
In May, 1850, a gentleman had the misfortune to
lose a good part of the left ala nasi. In the opera-
tion eight interrupted silver sutures were used — they
were removed on the 7th day : union was perfect,
and he soon went home with some slight tumefaction
of the parts, which gradually subsided.

IN PLASTIC SURGERY.

33

In the course of a fortnight he returned, saying
that in wiping the perspiration from his face, he
discovered some pricking substance at the seat of
the operation, which he supposed to be a bit of
wire. He was right ; the wire was there, but easier
felt than seen. It was removed, and found to be
half an inch long : it had remained there four weeks,
producing no sense of soreness, and no inflammation
or suppuration as a silk ligature would have done,
thus establishing the great and important principle
that silver was as innocuous as lead, and, like it,
might become sacculated, producing no irritant or
poisonous effect whatever.

I have used this simple suture with unvarying
success in other plastic operations, a detail of which
is here unnecessary.

In 1852 a little boy
some 8 years old re-
ceived a blow on the
upper lip, near the left
commissure, cutting it
through for f of an inch.
Three interrupted silver

sutures were applied, and n£ other dressing. I saw
no more of him till the ninth day : union was per-
fect, the wires remaining precisely as I had placed
them. Their removal was like that of a delicate ear-
ring from the ear long used to wearing it.

Fig. 18.

34

SILVER SUTURES.

In 1853 a gentleman called on me with a very-
bad cancroid warty excrescence, involving a large
part of the lower lip, which had resisted all reme-
dial efforts. Its removal was advised. He said he
could not possibly spare the time necessary for a
cure ; I told him that twenty minutes would suffice
for the operation and dressing, and that he could
then go home, (some 80 or 100 miles,) and return
in a week. He consented. The usual operation

vsatfj

Fig. 19.

by a V incision was performed, and the cut surfaces
united by four interrupted silver sutures, sustained
by a single strip of isinglass plaster, with no other
dressing. At the appointed time he returned with
the parts perfectly united throughout, the wires
producing no inflammatory effect whatever.

Would any surgeon have been justifiable in send-
ing such a case as this away for so long a time with

IN HARE-LIP. 35

the old-fashioned method by silk ligatures or the
twisted suture ? Certainly not. And yet I felt no
anxiety about the result, so great was my confidence
in the safety and security of the silver wire, as then
demonstrated by daily experience.

In Hare-lip the results of this suture are beau-
tiful. They should not be further apart than T 3 T of
an inch, or even less ; thus affording good support
and perfect co-aptation. It is necessary for them
to remain till union is firm enough to prevent any
widening of the cicatrice by muscular traction,
which requires usually from five to eight days.
As it is important to prevent any mark from
their unequal pressure, a thin plate of some trans-
parent material may be placed, like a delicate splint,
on the co-apted edges, over which the wires may
be tied, thus protecting the tender cuticle of the
child's lip from their cutting pressure ; while at the
same time it allows an inspection of the united
parts, which, if necessary, can be more accurately
fitted by gently insinuating a small probe under the
translucent medium : a thin bit of glass in the ab-
sence of any thing else answers the purpose admi-
rably well.

For this purpose I have had prepared some little
plates of ivory, made transparent by dissolving
its earthy constituents. This prepared ivory is

36 SILVER SUTURES.

thin, light, and capable of being cut or moulded
into any form, but it is objectionable, as it softens
at the temperature of the body.

However, nature has given us a better material
for this purpose, one to be found everywhere and
at any time. A clarified goose-quill split into sec-
tions, softened in boiling water, and then flattened
out by heavy pressure, fulfils every indication in this
" hare-lip suture." So far as absolute success in the
operation is concerned, nothing can be added to the
silver wire to make it more certain, and these trans
lucent media are recommended merely for the pur
pose of preventing scars that may result from the
pressure of the wire.

In Wounds of the Scalp, I have often applied
silver sutures, and here they possess a peculiar fit-
ness. They do away with the necessity for sticking
plasters, and there is no need of a razor. Besides,
of all regions of the human body this is most liable
to traumatic erysipelas, hence the importance of
dispensing with silk as a suture.

Dr. Emmet, the accomplished Assistant Surgeon
to the Woman's Hospital, removed in December,
1856, an encysted tumor from the scalp of a lady
aged 62. It had existed some forty years, giving
her no inconvenience until a few months before,
when it increased rapidly in size and became tender

IN HEROIC OPERATIONS. 37

on pressure. Six silver sutures and a water dress-
ing were applied. On the eighth day they were
examined for the first time. Found union by the
first intention — the wires had produced no irritation
whatever, and from appearances they might have
remained there without it for an indefinite pe-
riod, although she was below the average state of
health.

Having applied this simple suture with the same
unvarying success in all the minor operations, which
it is here needless to detail, would it not have been
strange had I failed to try it in the bloody or heroic
ones ? Indulge me a moment to enumerate a few
of them.

In 1849, 1852, and 1853, I removed the
Mamma, applying this suture, the number in each
case varying from eight to seventeen. The wires
were allowed to remain from seven to fifteen days.
It is almost needless to say that in every case the re-
sult was the same as in the smaller operations, —
complete cohesive union.

In 1852, (February,) I removed the principal
part of the lower jaw bone for osteo-sarcoma, in a
negro woman some 50 years old. It was divided
at the angles, thus necessitating an incision of about
ten inches after Mott's plan. The wound was

38 SILVER SUTURES.

united by eighteen silver sutures, and a simple sus-
taining bandage applied. The whole length of it
healed by the first intention, except an isolated
point at the middle of the chin, through which the
retaining ligature of the frsenum linguae had been
passed for security. The wires were not removed
for ten days. Had silk been used as a suture there
would have been an absolute necessity for their
removal in three days at the farthest, and even then
it is almost certain that the bed of each suture
would have been a suppurating sore.

In 1849, 1850, and 1852, I used silver sutures
in Amputations of the thigh and leg, and in every
case produced union by the first intention through-
out the whole extent of the wounds with the
exception of the point left for the passage of the
ligatures.

In all amputations, surgeons knowing the bad
effects of ordinary silken sutures, have been in the
habit of applying as few as possible, and trusting
to adhesive plasters and bandages to retain the
edges of the flaps in contact. The poisonous prop-
erties of silk render its early removal imperative ;
hence the wound must be disturbed before adhesion
is firm, and thus mischief results from the surgeon's
necessary interference. But when the silver wires
are applied, there is no necessity whatever, under

IN AMPUTATIONS. 39

ordinary circumstances, for any interference till the
parts are firmly united.

They must be placed near enough together to
bring closely and accurately into contact every por-
tion of the edges of the flaps, which may now be
sustained by a few long narrow strips of Liston's
Isinglass plaster. It takes a little longer, and it is
therefore a little more trouble, to apply nicely twelve
or fifteen silver wire sutures, than to stick in clum-
sily four or five great silk ligatures ; but when the
stump is dressed there is no more trouble with it,
and the wires may not be removed for eight or ten
days, or even longer. Moreover, there is not so
much excuse for compresses, bandages, Maltese
crosses, and all the bungling contrivances often
resorted to after amputations, while there is every
facility for applying a light water dressing, which is
the only thing usually needed in such cases. ■

In 1855, at the request of Dr. Willard Parker,
the distinguished Professor of Surgery in the Col-
lege of Physicians and Surgeons, I applied silver
sutures to a large abdominal section in the case of a
young lady, the subject of Ovariotomy. They were
passed deeply through the parietes of the abdomen,
but not perforating the peritoneal coat. Union by
the first intention was complete — the sutures re-
maining a week.

Other surgeons, members of this Academy, have

40 SILVER SUTURES.

been using this suture, amongst whom may be men-
tioned Mott, Post, Parker, Buck, Watson, Sayre, Van
Buren, James R. Wood, Markoe, Henry Weeks
Brown, and many others. Professors Mott, Post and
Parker, have each for the last four years taken
great pains to instruct their several classes in the
use of this American discovery.

But amongst the earliest to appreciate its impor-
tance in connection with medical education stands
pre-eminent, Dr. Gilman, the learned Professor ot
Obstetrics, etc., in the College of Physicians and
Surgeons.

Sufficient detail in the way of facts and dates
has now been given to place beyond controversy my
claims, not only to priority in the discovery and
promulgation of a great principle, but in its univer-
sal application in general surgery.

But all the special departments of surgery have
not been indicated in which this simple and won-
derfully beautiful suture may be successfully used.
As soon as I became aware of its value, I was very
anxious to apply it in Wounds of the Intestines, and
particularly after the occurrence already alluded to,
where a wire remained four weeks in the nose with-
out producing the slightest disturbance; but no
opportunity presented till April, 1853.

A young negro man was stabbed in the left side

IN INTESTINAL WOUNDS. 41

between the sixth and seventh ribs ; and in the ab-
domen there were two cuts, through which pro-
truded large masses of wounded intestines. These
intestinal wounds (some of them transverse, and
others diagonal) were closed with simple interrupted
silver sutures, which were cut off close to the intes-
tine, and the whole returned to the abdominal cavity.
He lived twenty -four hours.

The post-mortem examination, made by Dr. B. C.
Jones of Montgomery, Alabama-, and Dr. Cum-
mings, now of New Orleans, showed that the
thoracic wound had passed downwards through the
diaphragm into the stomach. The perforation in
the diaphragm was completely plugged by omen-
tum, but not till the contents of the stomach had
passed through it into the pleural cavity.

Fig. 20.

There was no effusion or evidence of active in-
flammation in the peritoneal cavity; the silver
wires had neatly closed the wounds in the bowel,

42 SILVER SUTURES.

(duodenum cut, ileum and jejunum transfixed in
three places,) and for an inch around them there
was a delicate little effusion of plastic lymph nicely
gluing the wounded parts to the adjacent perito-
neal coat, while every thing else was in a perfectly
normal state.

Fortunately he lived long enough to indicate
pretty clearly the propriety of using silver sutures
in wounds of the intestines. I expected them to
become sacculated like lead, and to remain there
innocuously, to be taken care of in nature's own way.

I have long felt satisfied that the great danger
from Wounds of the Peritoneum was due not so
much to the mere admission of atmospheric air as
to the universal use of ligatures and sutures, left like
setons to irritate and inflame this delicate serous
membrane. Operations for Hernia are of frequent
occurrence, and if performed before strangulation
results in sphacelus, are amongst the safest of all
grave operations. They show very plainly that the
peritoneum may be opened and handled with com-
parative immunity.* For the truth of this assertion

* Dr. Warren Stone, the distinguished Prof, of Surgery in the Medical
Department of the University of Louisiana, who, as a great practical teacher,
ranks with the most eminent in this country, or any other, says of hernia,

u That no disease is so dangerous to life, and yet so entirely remediable"

that u the bowel is in danger from the moment it is strangulated, and should
be relieved as soon as possible " — that u the hernial sac can be exposed without
the slightest risk"— and that u if it should be necessary to open the hernial
sac, it can be done with as much safety as venesection can be performed at the
bend of the arm." [New Orleans Medical Journal) Jan, 1858, page 79.]

IN OVARIOTOMY. 43

I appeal here to Mott and Stevens, to Watson and
James R. Wood, and to every other surgeon in this
Hall. Why then such dread of peritoneal wounds ?
Why such fear of peritonitis in Ovariotomy ?

But is there any wonder that Ovariotomy is so
fatal, when a great silken cord strangulates the
pedicle and hangs from the abdomen, its whole
track a suppurating sinus ? And, when six, or eight,
or ten silken sutures close the external wound, each
one answering most admirably the purpose of a
seton ?

Simpson, the great European luminary of Obstet-
ric Surgery, plainly saw the source of danger, and
says, "If betimes it come to be recognized as a surgi-
cal operation fit and proper in such cases of ova.
rian disease as he adverted to, he had no doubt the
steps of the operation itself would meet ivith improve-
ments" and that "probably it might be possible to
devise some other measures of securing the large
vessels, principally veins be it remarked, of the ped-
icle, and thus save the several dangers arising from
the ligature."*

Europe, through this great man, thus calls for
improved measures of safety, which America now
proudly lays at her feet. For silver sutures and
silver ligatures are to do more to rob this dread
operation of its dangers than all else that has yet

* Obstetrical Works, 1st Series, page 256.

44 SILVER SUTURES.

been suggested. Let the pedicle of the tumor be
firmly tied with a silver, or leaden wire — let the ex-
ternal wound be united by silver sutures — let the
vaginal cul de sac be punctured, (as has already been
done by our distinguished Fellow, Prof. Peaslee,)*
for a canula to drain off, through the most depend-
ent point of the peritoneal cavity, any exudation,

4

whether of blood, serum, or pus, and a degree of
security will be given to this operation that may
yet rank it with hernia under its most favorable cir-
cumstances.

But enough has been said to fix attention upon
the importance of this suture, and its universal ap-
plicability in general surgery.

It is to revolutionize surgical dressings, and to
ensure more beautiful and prompt cures. With it,
properly applied, there can be no gaping wounds
to heal by the suppurating process, where there
is skin enough to cover a stump ; and in many cases
erysipelatous inflammation, and even hospital gan-
grene, may be averted by substituting it for silk as
a suture.

After all amputations we must use sutures of
some sort ; and how often do we see silk ulcerating
out, and creating such tendency to suppuration,
that we are compelled to remove them before there
is sufficient uniop to resist the retraction of the tu-

* American Journal of Medical Science, Jan. 1857.

THEIR GENERAL USE. 45

mefied flaps. But with silver there is no inflamma-
tion, no suppuration, no cutting out of sutures, no
gaping or retraction of flaps, and therefore no neces-
sity for disturbing the dressing till all is firmly
united and permanently well.

This is no vain imagining : though enthusiastic,
I am not wildly so, for all this has been familiar to
me for the last eight years, and I but speak what I
know. The next eight years will not find an edu-
cated physician anywhere who will dare to use silk
sutures, for the silver thread will now become as es-
sential to the dressing case as the needle itself; and
if I may be allowed to venture a prediction, I will
say that fifty years hence the statistics of our hospitals
will show a vast improvement in their bills of mor-
tality after great operations, and this improvement
will be due mainly to the use of silver as a suture.

Look at its results in injuries of the vagina.
Before this discovery, operations for vesico-vaginal
fistula, and its congeneric affections, were often at-
tended with risk to life, while a cure was a mere
accident. But how is it now ? Why, every case is
easily and perfectly curable that has tissue enough
to render any operation whatever practicable ; while
a failure is the exception to the rule. Besides,
there is not the least risk to life, as there is
never any fever, or the slightest constitutional dis
turbance.

46 SILVER SUTURES.

I am not claiming too much for this suture when
I say, that the same relative results must be attain-
ed in all other surgical operations requiring sutures,
if the same method be adopted.

My language is in nowise extravagant; and I
shall yet live to see the day, when the whole pro-
fession of the civilized world will accord to this sim-
ple discovery the high position of being the most
important contribution as yet made to the surgery
of the present century.

The only thing at all comparable to it is Ether-
ization ; and in practical results of permanent bene-
fit it is absolutely contemptible, when compared
with those from the universal use of silver sutures
in the broad domain of general surgery.

Having now briefly shown that I have used sil-
ver sutures with uniform success in almost every
imaginable injury requiring sutures, these practical
remarks might very properly be here closed ; but,
as concentrated efforts have been made in various
quarters to rob me of full credit for my labors, I
have thought it due to truth, to justice, to poster-
ity, and to myself, to place permanently upon rec-
ord a history of the circumstances attending this
discovery.

Some of my contemporaries will not approve
the measure, but when this generation passes there

PERSONAL NARRATIVE. 47

will be no difference of opinion amongst critics on
this point; besides, it will not be unprofitable
should it stimulate but one young aspirant for fame
and fortune to redoubled efforts, under unpromising
circumstances and opposing obstacles, to the accom-
plishment of still more glorious triumphs for our
noble profession.

Although fully fortified by the necessity of self-
vindication, still I hesitate and tremble ; but why
should I be afraid to write, and speak, and publish
to the world, what I am not ashamed to acknowledge
to any individual, viz. — that it was all the result of
a Providential train of circumstances over which I
had no control, and that it pleased God to lead me
in this direction in spite of my predilections.

As the field of my labors thus partakes somewhat
of a missionary character, a labor of love under
Divine guidance for the furtherance of a truly be-
nevolent purpose, you will pardon a personal nar-
rative, which under other circumstances would be
inexcusable.

For the first ten years of my professional life
the treatment of any disease peculiar to woman was
ignored as far as possible. Surgery was my ambi-
tion, and it was gratified, for my head, and heart,
and hands were full. This was due, not to any par-
ticular merit on my part, but, to a fortunate position
amongst a liberal and enlightened profession in the

48 SILVER SUTURES.

noble state of Alabama, a profession, which, for in-
telligence and a chivalric esprit de corps, is not
behind that of any other state in this great confed-
eracy.

Thus situated, a case of vesico-vaginal fistula
was sent to me in July, 1845, which was investi-
gated more because I had a surgical reputation to
sustain than from any particular interest in the sub-
ject. It was, of course, dismissed as incurable.
Two months after this another presented, which re-
ceived a like verdict. Two cases in such quick suc-
cession in a country town, at that time, formed an era
in one's life; imagine my surprise, when, • a few
weeks after this, a gentleman called to consult me
about a third case. I told him promptly that it was
useless to send her to me, as the injury was wholly
incurable. He suggested that there was a possi-
bility of my being mistaken in my ready diagnosis ;
when I replied, that a leakage of urine following a
protracted labor was an infallible sign of a vesical
fistula. But my remonstrances were unavailing, for
he sent her to town in spite of me.

I investigated the case thoroughly, reading
every author I could find on the subject, but to no
purpose, for all was darkness and confusion ; and
thus I was on the eve of sending her home, when a
little incident occurred that formed the turning point
of my professional career, and without which the

PROVIDENTIAL INCIDENT. 49

discovery that has engaged our attention to-night
would not have been made.

A lady was riding in the suburbs of the city of
Montgomery, Alabama, and her pony taking fright,
jumped suddenly, when she fell to the ground,
striking on the sacrum. I saw her soon afterwards;
her sufferings were extreme, as she had rectal and
vesical tenesmus from a sudden retroversion of the
uterus. To replace the dislocated organ was the
indication of relief. Following the teachings of
learned professors, the patient (covered with a
sheet) was placed on the knees with the pelvis ele-
vated, and the thorax depressed, when by manipu-
lation through the vagina and rectum, I hoped to
replace it. Introducing the right forefinger into
the vagina, but remembering how a nervous gen-
tleman had suffered a few days before from a rectal
examination, I concluded not to subject this lady to
the same disagreeable operation, particularly as it
seemed possible to overcome the difficulty if my
finger was only a little longer. My middle finger
is more than half an inch longer than the index, but
it could not be used without its fellow ; and thus
the two were passed, and in a few seconds I could
not touch the uterus, or even the walls of the vagina,
and the fingers were swept around as it were " in
empty nothingness," which was to me at the moment

50 SILVER SUTURES.

a most puzzling mystery, and while I was endeavor-
ing to unravel it, my patient exclaims, " Oh doctor,
I am relieved !" My office was ended, for my mission
was to relieve her, but how it was done I could not
understand. While I stood doubting and wonder-
ing, my patient, now easy, threw herself down on
her side, producing thereby a sudden escapement
of air from the vagina ; and thus the whole mystery
of the accidental reduction of the dislocated uterus
was explained on the principle of atmospheric pres-
sure.

And what was its rationale ? When the patient
was in the position described, there being a natural
tendency of the pelvic viscera to gravitate towards
the epigastric region, it would require no great vis
a tergo to produce the desired result in a recent case
of this kind. One finger, however, was not long
enough to throw the organ up, nor were the two ;
but when they were both introduced, in my vary-
ing manipulations and strenuous efforts, the hand
was accidentally turned with its palm downwards,
which thus brought the broad dorsal surface of the
two parallel fingers in contact with the vulvar com-
missure, thereby elevating the perineum and ex-
panding the sphincter muscle, which allowed the
air to rush into the vagina under the palmar surface
of the fingers, where, by its mechanical pressure of
fifteen pounds to the square inch, this canal was

NEW HOPES SUDDENLY INSPIRED. 51

dilated like a balloon, and the uterus replaced by
its pressure alone. This accident — there are no
accidents in the providence of God ! — this inci-
dent, then, occurred just at the right time. Had it
happened six months sooner, its importance would not
have been duly appreciated. Had it been six days
later, the golden opportunity for its practical appli-
cation would have been lost forever ; for my mind
had been sorely perplexed by the obscurity sur-
rounding the investigation of the cases before
alluded to, and I said to myself, u If by this position
the atmospheric air can be made to dilate the vagina
to such an extent, even with a force strong enough
to reduce a dislocated uterus, why will not the same
principle allow me to explore this region, and exam-
ine accurately any injury, or disease to which it may
be liable ?" Full of the thought I hurried home — and
the patient, (with vesico-vaginal fistula,) who was to
have left on the next day, was placed in the position
described, with an assistant on each side to elevate
and retract the nates. I cannot, nor is it needful to
describe my emotions, when the air rushed in and
dilated the vagina to its greatest capacity, whereby
its whole surface was seen at one view, for the first
time by any mortal man.. With this sudden flash
of light, with the fistulous opening seen in its proper
relations, seemingly without any appreciable process
of ratiocination, all the principles of the operation

52 SILVER SUTURES.

were presented to my mind as clearly as at this time.
And thus in a moment, in the twinkling of an eye,
new hopes and new aspirations filled my soul, for a
flood of dazzling light had suddenly burst upon my
enraptured vision, and I saw in the distance the
great and glorious triumph that awaited determined
and persevering effort. From this moment my high
resolve was taken ; nor did I think, or care for the
personal sacrifices I should have to make. I thought
only of relieving the loveliest of all God's creation
of one of the most loathsome maladies that can
possibly befall poor human nature; and in this, I
honestly confess that I was stimulated by feelings of
national pride, as well as by a desire to advance our
glorious profession. Full of sympathy and enthusi-
asm, thus all at once I found myself running headlong
after the very class of sufferers that I had all my pro-
fessional life most studiously avoided. Ransacking
the country around, my medical brethren soon dis-
covered and placed at my disposal, some seven or
eight cases of vesico-vaginal fistula that had been
quietly laid up as incurable. Building a little hos-
pital as a special field of experiment, I readily
got control of these cases, all of them healthy young
negro women ; promising to perform no operation
that would endanger life, or render their condition
any worse. Having no proper instruments, and no
instrument maker, dentists, jewellers and black-

FIRST EXPERIMENTS. 53

smiths were laid under contribution, and soon such
rude instruments were made as were suggested by
the peculiar wants of individual cases. This occu-
pied a period from the 9th of December, 1845, to
the 10th of January, 1846, when the first operation
was performed.

Several medical friends, amongst whom were
Drs. Boling, Holt, Ames, Baldwin, Jones, McWhor-
ter and Henry 7 were invited to the inauguration of
the experimental series. When the mechanical
contrivances were exhibited, the peculiarities of
each case pointed out, and the principles of the
operation explained, they thought my plan of pro-
cedure promised well, while some were but little
less enthusiastic than myself in hopes for the future.

The first was a very simple case, and one that
any tyro in surgery could now cure in a week's
time. The fistula was an
inch and a quarter long,
transverse, in the base of
the bladder, with an abun- Flg - 21 *

dance of tissue. Its edges were accurately adjusted,
and I expected to effect at once a magical cure ;
but greatly to my surprise and mortification it was
a failure. However, the size of the opening was
reduced from that seen in the diagram to one not
larger than a No. 4 bougie: this encouraged me
considerably, and the same operation was tried on

54 SILVER SUTURES.

another case with a like unfortunate result, and after
this, with various, and constantly varied modifica-
tions on others, till each one had suffered numerous
operations, but all to no purpose. And thus I
worked on, not for weeks and months, but for long
weary years, before a single case was cured. My
repeated failures brought a degree of anguish that
I cannot now depict, even were it desirable. All
my spare time was given to the development of a
single idea, the seemingly visionary one of curing
this sad affliction, which not unfrequently follows
the fulfilment of the law pronounced by an offend-
ed God when he said to the woman, u In sorrow
and suffering shalt thou bring forth children."

Soon my friends began to despair of my efforts,
and one by one became tired of such profitless work.
At last Dr. B. R. Jones, my partner, an accomplished
physician, who had stood firmly by, giving his valua-
ble advice and assistance, importuned me to cease
my efforts; thus opposed at home, and deserted by the
professional brethren who once cheered me on by
their personal presence, I now stood alone — alone !
did I say ? no, I was not alone, for I felt that I had a
mission, if not of a Divine character, at least but
little short of it, of Divine origin. I felt that the
God who had called me to this good work, and in-
spired me with new views for its accomplishment,
was with me, and would not desert me. I could

woman's moral courage. 55

not have ceased my labors if I had tried, for some-
thing told me that the fulness of time had arrived,
that the work had to be done, and that if I should
fall, God in his wisdom would raise up some one as
an instrument to carry it forward to a glorious con-
summation. I was not alone then ; — nor was I alone
in another sense, for I had succeeded in infusing my
own courage and enthusiasm into the hearts of the
half dozen sufferers who looked to me for help, and
implored me to repeat operations so tedious, and at
that time often so painful, that none but a woman
could have borne them.

To the indomitable courage of these long-suffer-
ing women, more than to any one other single cir-
cumstance, is the world indebted for the results of
these persevering efforts. Had they faltered, then
would woman have continued to suffer from the
dreadful injuries produced by protracted parturi-
tion, and then should the broad domain of surgery
not have known one of the most useful improve-
ments that shall forever hereafter grace its annals.

In my first experiments the quilled suture was
used, securing the ligatures by passing them through
little canulae that projected from the vulva.

Fig. 22, shows the rude contrivance, which
was made of silver. The canulse were firmly
soldered to the proximal quill, and when the liga-
tures were tightened and wrapped round the end

56

SILVER SUTURES.

that projected from the vagina, the fistulous edges

were neatly co-apted by
the quills. This is intro-
duced merely to show the
slow degrees by which
practical truths are some-
times developed. After
using this machine various-
ly modified for nearly three
years, giving attention
mostly to the perfection
of the self-retaining cathe-
ter, I at last concluded that
the projecting canulae were
a chief cause of failure,
and consequently deter-
mined to dispense with
them: but how to secure
the ligatures was the ques-
tion. A detail of the num-
berless expedients resorted to is useless ; suffice it to
say, that I was at last driven completely to the wall.
I had resolved never to repeat another operation
till I had devised some plan of fastening the quill
suture without the canulae — of tying a knot where
I could not reach it with the fingers. Thus my brain
was sorely puzzled ; I had not performed an opera-
tion for nearly six weeks, and my devoted patients

THE PERFORATED SHOT. 57

were begging me from day to day, to " try only one
more time." Notwithstanding their importunities, I
had determined first to invent a knot for my sutures ;
but it seemed that my usual readiness of expedient
had now deserted me. My brain was oppressed ; my
heart was heavy ; but never for one moment did I
despair of eventual success. At last I happened to
remember that, when a boy, I used to make sinkers
to my fishing lines by cutting a shot half in two, lay-
ing the line in the cut, and then compressing the
shot on it with my teeth. I cannot express the de-
light that filled my heart at this simple suggestion.
The idea occurred to me on the night of the 14th
November, 1 848. The contemplation of its beauty,
simplicity, and perfect adaptation to the purpose,
gave me a sleepless night ; for there I lay with
etherealized brain, performing in imagination a
magical cure on each of my devoted patients. This
was, as I thought, the consummation of all my plans.
After a struggle for three years, victory was about
to crown my efforts. How I longed for the morn-
ing, that I might put to the test of experiment what
seemed so beautiful in theory. But I was doomed
to wait another twenty-four hours before proving
my principle ; for just as I was preparing for the
operation, a call to the country appropriated the day,
and thus the longest day of my life was lengthened
out by hope deferred. But bright and early on the

58 SILVER SUTURES.

succeeding morning, I applied the quill suture se-
cured by the perforated shot. It was all I could
desire — I was never so well satisfied with any ope-
ration in all my life. How anxiously I waited for
its results. I had at last gotten rid of the canulae
that had so long been such a serious obstacle to
success, and every thing was propitious ; but these
bright hopes were of short duration, for I soon had
unmistakable evidence that the operation was a
total failure. What was the cause of it? why, said
I, it must be because the silver quills are too large ;
so I began to lessen their size till they were not
more than a line in diameter, and on account of the
expense of silver, lead was substituted : but notwith-
standing these modifications, there was no more suc-
cess than at the beginning. What now was to be
done ? The principles of the operation were clear,
and its mechanism seemed to be perfect. At first I
had supposed my failures were due to the imperfec-
tion of the catheter ; that was perfected, and then
I laid the blame on the method of securing the su-
tures by means of the canulae ; they were replaced
by the perforated shot, and then I looked to the
size of the quills, and reduced them, so that they
burrowed nicely in the tissues: it then seemed that
success was inevitable, but still disappointment
awaited me at every turn.

Thus far all my experiments were conducted on

HOW FIRST SUGGESTED. 59

the principles of a rational inductive philosophy.
The operation was mechanically perfect, but with
no better results than when it was rude and clumsy.
There must be a reason for all this — what was it ?
Why, said I, perhaps it is in the nature of the mate-
rial more than in its principle of action ; what a
happy thought ! — Of course it was, for a silk thread
introduced under the skin, and allowed to remain a
week, becomes a seton, giving rise to the suppura-
tive process, and certainly the same thing must oc-
occur with it in the vagina ; and how then could
there be cohesive union ? Here then was the diffi-
culty at last ; how strange it now seemed to me that
this fact had not long ago forced itself upon my
mind. Now the question arose, was there a substi-
tute for silk that would answer the same purpose,
and yet not poison the animal tissue ? Why, lead
remains indefinitely in the body, becomes sacculated,
and produces no poisonous, or suppurative effect.
Dr. Levert * of Mobile, had demonstrated the innoc-
uousness and efficiency of leaden ligatures on the
arteries in the lower animals, and Mettauer and Dief-
fenbach had actually used leaden sutures in these
very cases ; and I had in my various experiments
tried them in two cases of vesical, and one of rectal
fistula, but fortuijately for science, the clumsy leaden
wire was unsuccessful in my hands. Was there any

* American Journal of Medical Sciences, No. VII., May, 1829.

60 SILVER SUTURES.

other metal that could be substituted for lead, pos-
sessing its valuable property of harmlessness ?

In this train of inquiry what would be more
readily suggested to the reasoning mind than silver,
gold, and platinum?* Just at this stage of affairs I
happened to pick up a piece of brass wire, that had
been used in a pair of old fashioned suspenders made
before the days of India rubber ; it was as fine as or-
dinary sewing thread. I took it to a jeweller, who
imitated it in silver. I was now quite as anxious to
see the result of an experiment with this, as I was
seven months before to see the perforated shot ap-
plied. On the 21st June, 1849, it was done. A
young colored woman, who had never murmured
at the preceding failures, was placed on the ope-
rating table for the thirtieth time, and the silver
sutures were applied, with the leaden bars and the
perforated shot. In all previous operations the ure-
thra, in a day or two, would become red and ten-
der, and the urine loaded with thick tenacious
mucus, thus showing the inflammatory process,
which was adverse to union ; but after this opera-
tion, the urine remained perfectly limpid all the
time, and on the eighth day the parts were per-
fectly healed; the suture apparatus remaining just

* All these I have used, but adopt the silver, because it is as good as gold,
and cheaper.

WHEN FIRST PUBLISHED. 61

as it was placed, with the crossbars somewhat bur-
rowed in the vaginal tissue.

I shall not dwell upon my feelings at this time. At
last I had attained what I had worked for nearly four
years ; and it was but a few weeks before all the
cases were cured that had been the subject of ex-
periment for so long a time. I was anxious to get
a few more cases to settle some doubtful points, be-
fore publishing to the world my discovery ; but un-
fortunately with the realization of my dreams, and
in the full fruition of my most sanguine hopes, came
a sad reverse. An exacting practice and the ex-
treme mental tension of the past four years had
produced a collapse, long foreseen by friends, with-
out my consciousness of its approach. Having con-
tracted the chronic disease of a warm climate, which
is almost universally fatal, and struggled hard for
more than two years, and as it seemed, hopelessly
against my fate, thus seeing that death was inevitable,
and fearing' that I might die without the world's
reaping the benefit of my labors, I determined to
give my experience, crude as it was, to the profes-
sion that I loved so much. And accordingly, in Oct.
1851, my paper u On Vesico-Vaginal Fistula" was
dictated, and sent to Dr. Isaac Hays, of Philadelphia,
who published it in the Am. Jour, of Med. Sciences
for Jan. 1852, as my last free-will offering on the
altar of science. I little thought of living to see it

62 SILVER SUTURES.

in print, but it has pleased an All-wise God to re-
store me again to health, and by a mysterious Prov-
idence to place me in your midst, where I have
found nought but friends and kindness.

Mr. President, I have thus hastily sketched a
truthful, unexaggerated statement of the train of cir-
cumstances, which led to results that must ever be
remembered as an achievement of American Sur-
gery. But, Sir, I feel that an apology is due this
Academy, for a personal narrative, although neces-
sary for the vindication of right and the establish-
ment of truth.

«

Fellow Associates :

I have said much of Silver Sutures, showing
what they have already done, and pointing out the
great revolution they are to effect in all surgery ;
but my task would be unfinished were I not to lay
before you in this connection every good work they
have achieved, — indulge me then a moment longer.

In justice to the Medical Profession of this
mighty Metropolis, which is truly represented by this
Academy, I beg leave here to state a few facts that
must necessarily become historic; and, if historic,
could the occasion be more propitious than now, in
this beautiful new edifice of the New York Histori-
cal Society, which was but last night dedicated

ORIGIN OF WOMAN'S HOSPITAL. 63

by an eloquent address from the venerable and
learned Dr. Francis.

But for Silver Sutures, that noble Charity, the
Woman's Hospital, would not have been called into
existence. — Do you ask how this is so? Let me
glance briefly at its origin.

As before remarked, driven by a seemingly in-
exorable fate from my Southern home and friends
in search of health, repeated observations made
during the summers of 1850, 1851, and 1852,
showed that I could regain it in this great city —
and nowhere else — for whether I crossed over to
Brooklyn, sailed up the Sound to the "land of
steady habits," roamed over the Highlands of the
noble Hudson, quaffed the waters of the far-famed
Saratoga, loitered by the seaside, or scaled New
England's lofty mountains, it was all the same with
me — but, whenever I tarried in New York, its pure
soft Croton water and bracing air, would invariably
banish my dread disease. Thus the law of self-
preservation drove me here in spite of sectional
prejudice and an innate horror of a large city. Soon
after my arrival, on the 15th of October, 1853, Dr.
Mott called, and gave me the first patient I ever
had in New York. It was a very bad case of utero-
vesico-vaginal fistula, which had been sent to him
from Canajoharie.

Having read an account of Silver Sutures, he

64 SILVER SUTURES.

honored me with a request to apply them in this
case, which, so far as the records show, was the first
of the kind ever remedied in the State of New
York. This brought me frequently in contact with
Dr. Mott, who encouraged and sympathized with
my views on the necessity of establishing a great
hospital in this city to be devoted to the treatment
of the diseases peculiar to woman. He sent me to
Dr. Francis, whose broad and comprehensive views
greatly contributed to shaping its destiny. Dr.
Francis saw at once its bearings upon the interests
of humanity, the advancement of science, and the
cause of Medical Education. He was its earliest
advocate, its unwavering friend. To his personal
influence and overpowering eloquence is due in a
great measure the hold it has upon the sympathies
of the community, and the confidence of the Pro-
fession — well may he be styled God-Father to the
Woman's Hospital.

Dr. Horace Green, the founder of the New York
Medical College, was too much interested in the
cause of medical education not to see its importance,
and he aided it with wise counsel and earnest
effort.

Dr. Griscom, Dr. Barker, Dr. Gardner, and Dr.
Reese, were amongst its earliest friends. But the
first man to suggest a proper method of co-operative
action was Dr. Alexander H. Stevens, who, though

ENDORSEMENT OF MEDICAL PROFESSION. 65

little given to enthusiasm on ordinary occasions,
seemed to be fired with this idea of a Woman's
Hospital, and wrote a letter to Bishop Wainwright,
(which is now in the possession of the Rev. Dr.
Muhlenberg,) and taking a broad view of the sub-
ject, he at once said: " You are right in thinking
this movement should emanate from the Medical
Profession ; a meeting must be called, and you must
address it." But I declined, because I was unused
to public speaking, and feared to endanger a good
cause by a possible failure.

However, I soon discovered that I could do
nothing otherwise, and was forced to adopt the sug-
gestion of Dr. Stevens, inviting the Profession to a
lecture on the subject at the Stuyvesant Institute,
No. 659 Broadway, on the 18th of May, 1854.

The interest felt was manifested by a large
attendance, representing every phase of the Profes-
sion. After the lecture, Dr. Delafield was called to
the chair, and Dr. Beadle requested to act as secre-
tary, when Dr. Griscom moved " That the meeting
coincide to the utmost extent with the views of the
lecturer of the evening," sustaining his motion ably
and eloquently. He was followed successively by
Drs. Gardner, Greene, Kissam, Reese, and others,
when the meeting unanimously adopted the hospital
movement as its own, authorizing the chairman to

appoint at his leisure, a committee of ten, five lay-

5

66 SILVER SUTURES.

men and five medical men, to organize plans for
future action; Dr. Delafield was added by this
meeting to the committee which it authorized him
to appoint.

The selection of this committee was a matter of
grave importance, — how could it be composed so as
to combine all interests in the Profession into one
harmonious whole ? How else but by representing
the cause of Medical Education? Accordingly, Dr.
Stevens, from the College of Physicians and Sur-
geons,— Dr. Mott, from the University Medical
College, — Dr. Green, from the New York Medical
College, — Dr. Francis, as the Father of Obstetric
Medicine in New York, — with Dr. Delafield and
your Orator, comprised the medical branch of the
Committee — while Mr. Peter Cooper, and Mr. Eras-
tus C. Benedict, were the only laymen ever selected.

This endorsement by the united voice of the
Profession was the quickening principle in this hos-
pital movement ; without it, there could have been
no vitality — no existence.

The kindly sympathy of the Profession was
shown, too, by a liberal patronage in placing at my
command a large number of surgical cases, fit sub-
jects for Silver Sutures, that were clamorous for aid.
Having no place for them, and feeling the urgency
of prompt action, then it was that the members of
this Committee allowed me to appeal to the mothers

woman's hospital association. 67

of our city to aid us in this good work for their suf-
fering sisters.

The time has not arrived for a complete histori-
ography of the Woman's Hospital, and it is not my
intention here to individualize the noble band of
heroic women, who, when we had been working for
several months with no practical results, called a
meeting of some thirty ladies in the quiet parlor of
a private residence, (No. 27 St. Mark's Place,) on
Saturday the 10th of February, 1855, when the
" Woman's Hospital Association" was formed,
which elected a Board of Managers with the fol-
lowing officials, viz. : —

Mrs. David Codwise, . . . . 1st Directress,

" Wm. B. Astor, 2d

" Ogden Hoffman, 3d

" Jacob Leroy, Treasurer,

" T. C. Doremus, Assist. Treas.

" Dr. Horace Webster, .... Secretary.

This Board raised funds, rented a building, No.
83 Madison Avenue, and opened the hospital on the
4th of May, 1855, electing the gentlemen as its
Medical Board who had been previously appointed
as a committee of organization.

Nor did they stop here ; for as soon as they saw
the need of more room, they joined the Medical
Profession in an appeal to the Legislature for funds

cc

u

68 SILVER SUTURES.

and a new Charter, merging it into a State Institu-
tion, of which the present Board of lady Managers
will constitute a Board of Supervisors having charge
of its domestic management, while its Board of Gov-
ernors, composed of New York's choicest sons, will
organize it and manage its finances. And what are
now its prospects for the future? With fifty-six
thousand dollars in hand, with an implied under-
standing in our Charter to get from the State a large
appropriation as soon as her financial condition will
allow it, with a sympathy for its success that per-
vades every intelligent family in the city, and many
throughout the State, and with the expectation of
obtaining from the city a site valued at a hundred
thousand dollars — does not the Woman's Hospital
bid fair to take its place as one of the fixed institu-
tions of the country ? And who should feel prouder
of this than this Academy ? Although the Acad-
emy had no opportunity, as such, of moving in the
matter, still the leading members of this learned
body are its prominent friends. The Medical Pro-
fession have never before, in any country, shown
such unity of purpose as here, in regard to this
Woman's Hospital. Look for a moment at their
Memorial to the Legislature last year in its behalf.
it was signed by every Professor in the College
of Physicians and Surgeons; by every Professor
in the University Medical College ; by every Pro-

UNITED MEDICAL PROFESSION. 69

fessor in the New York Medical College ; % by all
the leading practitioners of the city to whom it was
presented ; by every Physician to each of our five
Dispensaries ; by the Surgeons and Physicians to all
our other Hospitals, and when it was sent to Albany,
it received the unanimous endorsement of the
State Medical Society. Was ever before such union
seen in the Medical Profession ? Pardon me if I
should call it a u Union by the first intention/'
effected by Silver Sutures.

CATALOGUE OF THE

OFFICERS AND CORRESPONDING AND RESIDENT FELLOWS

OF TriE

NEW YORK ACADEMY OF MEDICINE.

-*♦*-

OFFICERS FOR 1847.

President, John Stearns, M.D.

{Francis U. Johnston, M.D.
Thomas Cock, M.D.
John B. Beck, M.D.
John W. Francis, M.D.

Recording Secretary, F. Campbell Stewart, M.D.

Domestic Corresponding Secretary, William C. Roberts, M.D.

Foreign Corresponding Secretary, Benjamin Drake, M.D.

Treasurer, Robert Watts, Jr., M.D.

Librarian, Thomas M. Markoe, M.D.

Orator, John W. Francis, M.D.

OFFICERS FOR 1848.

President, John W. Francis, M.D.

f Thomas Cock, M.D.
_ . , John B. Beck, M.D.

Vice-Presidents, ^ j K Rqdgers, M.D.

[w. W.Miner, M.D.

Recording Secretary, F. Campbell Stewart, M.D.

Assistant Secretary, Marcus L. Taft, M.D.

Domestic Corresponding Secretary, William C Roberts, M.D.

Foreign Corresponding Secretary, Gurdon Buck, Jr., M.D.

Treasurer, James 0. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, James R. Man ley, M.D.

72 OFFICERS, ETC., OF THE

OFFICERS FOR 1849.

President, Valentine Mott, M.D.

(Isaac Wood, M.D.
James R. Manley, M.D.
Galen Carter, M.D.
Thomas Cock, M.D.

Recording Secretary, John L. Vandervoort, M.D.

Assistant Secretary, T. M. Franklin, M.D.

Domestic Corresponding Secretary, Wm. C. Rorerts, M.D.

Foreign Corresponding Secretary, John G. Adams, M. D.

Treasurer, James 0. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, Alfred C. Post, M.D.

OFFICERS FOR 1850.

President, Isaac Wood, M.D.

r Galen Carter, M.D.
Tr . r> ., . Joseph M. Smith, M.D.
V«*-PreszdentsA j. C . Bliss, M.D.

A. C Post, M.D.

Recording Secretary, John G. Adams, M.D.

Assistant Secretary, Jackson Bolton, M.D.

Domestic Corresponding Secretary, Wm. C. Roberts, M.D.

Foreign Corresponding Secretary, Edward L. Beadle, M.D.

Treasurer, James 0. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, Joseph M. Smith, M.D.

OFFICERS FOR 1851.

President, Alexander H. Stevens, M.D.

f Galen Carter, M.D.

T7 . n ., . ! Joseph M. Smith, M.D.
Vice-Presidents, < T jr t> ' lfn

' John K. Rodgers, M.D.

John P. Batchelder, M.D.

Recording Secretary, John G. Adams, M.D.

Assistant Secretary, Jackson Bolton, M.D.

Domestic Corresponding Secretary, Wm. C. Roberts, M.D.

Foreign Corresponding Secretary, Edward L. Beadle, M.D.

Treasurer, James 0. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, F. Campbell Stewart, M.D.

NEW YORK ACADEMY OF MEDICINE. 73

OFFICERS FOR 1852.

President, Thomas Cock, M.D.

'Joseph M. Smith, M.D.

T .. _ . , James Anderson, M.D.

Vice-Presidents, A j p BatchelI)ERj m . d .

Gurdon Buck, Jr., M.D.

Recording Secretary, Jackson Bolton, M.D.

Assistant Secretary, George A. Peters, M.D.

Domestic Corresponding Secretary, Wm. C. Roberts, M.D.

Foreign Corresponding Secretary, Edward L. Beadle, M.D.

Treasurer, James 0. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, F. Campbell Stewart, M.D.

OFFICERS FOR 1853.

President, Isaac Wood, M.D.

f E. L. Beadle, M.D.
T ,. T3 ., F. C. Stewart, M.D.

Vice-Presidents, 1 Wm DetM0 ld, M.D.

I^Willard Parker, M.D.

Recording Secretary, Samuel A. Purdy, M.D.

Assistant Secretary, J. Foster Jenkins, M.D.

Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.

Foreign Corresponding Secretary, S. Conant Foster, M.D.

Treasurer, James 0. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, J. A. Swett, M.D.

OFFICERS FOR 1854.

President, Joseph M, Smith, M.D.

f James Anderson, M.D.

TT . D ., . j E. L. Beadle, M.D.
Uce-PresidentsA Wm DetmoU)j lUD .

[ J. H. Griscom, M.D.

Recording Secretary, Samuel A. Purdy, M.D.

Assistant Secretary, Edwin B. Stimson, M.D.

Domestic Corresponding Secretary, Samuel T. Hubbai:d, M.D.

Foreign Corresponding Secretary, S. Conant Foster, M.D.

Treasurer, Jamks 0. Pond, M.D.

Librarian, THOMAS V. Cock, M.D.

Orator, John H. Griscom, M.D.

74 OFFICERS, ETC., OF THE

OFFICERS FOR 1855.

President, John W. Francis, M.D., LL. D.
f E. L. Beadle, M.D.

Vice-Present^ \ F * C ' Stewart > MD -
vice cements, ^ GuRDON BuCK> M ^

^Wm Detmold, M.D.

Recording Secretary, S. Con ant Foster, M.D.

Assistant Secretary, John W. Green, M.D.

Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.

Foreign Corresponding Secretary, John G. Adams, M.D.

Treasurer, James O. Pond, M.D.

Librarian, Thomas F. Cock, M.D.

Orator, John Watson, M.D.

OFFICERS FOR 1856.

President, Willard Parker, M.D.
f John Watson, M.D.

Vice-Presidents, \ Jackson Bolton M.D.
j Gurdon Buck, M.D.
[_ Edward L. Beadle, M.D.
Recording Secretary, S. Conant Foster, M.D.
Assistant Secretary, W. F. Holcomb, M.D.
Domestic Corresponding Secretary, Samuel T. Hubbard, M.D.
Foreign Corresponding Secretary, John W. Green, M.D.
Treasurer, James 0. Pond, M.D.
Librarian, Thomas F. Cock, M.D.
Orator, Wm. Detmold, M.D.

OFFICERS FOR 1857.

President, Valentine Mott, M.D.
f James R. Wood, M.D.

Vice-Presidents A ? DWA 5? L ' Bea ?^ M.D.
John Watson, M.D.

B. Fordyce Barker, M.D.
Recording Secretary, C. F. Heywood, M.D.
Assistant Secretary, F. U. Johnston, Jr., M.D.
Domestic Corresponding Secretary, Samuel T. Hubbard, M D.
Foreign Corresponding Secretary, John W. Green M.D.
Treasurer, James 0. Pond, M.D.
Librarian, Thomas F. Cock, M.D.
Orator, J. Marion Sims, M.D.

NEW YORK ACADEMY OF MEDICINE. 75

OFFICERS FOR 1858.

President, J. P. Batchelder, M.D.

fC. E. Isaacs, M.D.

rr t> • 7 , W. H. Van Buren, M.D.
\ tee-Presents, i JoHN Watson> m ^

S. Conant Foster, M.D.

Recording Secretary, C. F. Heywood, M.D.

Assistant Secretary, F. U. Johnston, M.D.

Domestic Corresponding Secretary, Samuel T. Hubbard, M.D,

Foreign Corresponding Secretary, John W. Green, M.D.

Treasurer, James O. Pond, M.D.

Librarian, Samuel Rotton, M.D.

Orator,

TRUSTEES.

R. S. Kissam, M.D. J. H. Griscom, M.D.

James Anderson, M.D. E. L. Beadle, M.D.

Benjamin Ogden, M.D. Galen Carter, M.D.

W. N. Blakeman, M.D.

CORRESPONDING FELLOWS.

[Those marked with an asterisk are decease*!.]

Thomas W. Blatchford, M.D., Troy, *Bureaud de Riofrey, M.D., Paris.

N. Y. Samuel D. Gross, M.D., Philadelphia,

Jean Civiales, M.D., Paris. Perm.

♦Theodoric Romeyn Beck, M.D., Al- Philip Ricord, M.D., Paris.

bany, N. Y. " Alfred L. M. Velpeau, M.D., Paris.

Thomas Harris, M.D., Washington. J. C. Townsend, M.D., Long Isl., N.Y.
Louis Agassiz, Prof. Harvard Univer- Jean Jacques Joseph Leroy d'Etiolles,

sity. M.D., Paris.

Sir Henry Holland, M.D., London. Prince Krom Luang Wongsa Tirat
Martial Dupierris, M.D., Havana. Sanit, Siam.

Ashbel Smith, M.D., Texas. Paul Dubois, M.D., Paris.

William Fergusson, M.D., London. G. Andral, M.D., Paris.
Samuel H. Dickson, M.D., Charleston, F. Rilliet, M.D., Paris.

S. C. E. Barthez, M.D., Paris.

Worthington Hooker, M.D., New Ha- J. Guggenbuhl, M.D., Paris.

ven, Conn. Jacob Bigelow, M.D., Boston.

E. D. Fenner, M.D., New Orleans. James Y. Simpson, M.D., Edinburgh.
P. M. 1 toget, M.D., London. John Hughes Bennett, M.D., Edin-

P. V. Z. Amussat, M.D., Paris. • burgh.

Edward Revnolds, M.D., Boston, Mass. Edward K. Peaslee, M.D., N. Hamp-
*Joel A. Wing, M.D., Albany, N. Y. shire.

76

OFFICERS, ETC., OF THE

RESIDENT FELLOWS.

Abbott, Norman
Acosta, Elisha
Adams, John G.
*Andariese, James W.
Anderson, James
Andrews, Jarvis M.
Ashburn, Robert A*
Aylett, Philip Augustus
Ayres, Daniel, Jr.

*Barker, Luke
Bartles, 0. S.
Barker, B. Fordyce
Barry, Robert A.
Batchelder, J. P.
Bay, John W.
Baylies, Bradford S. B.
Baylies, Hersey
Beadle, E. L.
Beales, J. C.
*Beals, Gorham
*Beck, John B.
Bedford, G. S.
Benedict, George
Berger, Francis E.
Blakeman, Wm. N.
*Bliss, James C.
Bliven, J. P.
Blois, Samuel
Blumenthal, Mark
Bogert, Cornelius R.
Bogert, S. V. R.
Bolton, Jackson
Borrowe, J. H.
Bowen, William
♦Boyd, Thomas
Booraem, Augustus C.
*Brady, Patrick J.
Brown, Henry Weeks
Brown, William K.
Brueninghausen, Charles
Buck, Gurdon
Buel, W. P.
Bulkley, H. D.
Bum stead, F. J.
*Bullus, Edward
Budd, Chas. A.
Burke, Wm. C.
Busteed, John
Burrill, James
Byrne, John

*Cameron, James
Cameron, John S.
^Campbell, James
Campbell, N. L.
Carroll, Daniel J.
Carter, Galen
Carter, J. S.
Catlin, S. H.
Chalmers, Thomas C.
Chapin, E. R.
*Chapin, John R.
Cheesman, John C.
Childs, S. Russell
Church, Allen S.
Clark, Alonzo
Clark, Patrick
Clark, Peter F.
Clarkson, C. V.
Clements, J. W. G.
Clinton, Alexander
Cock, Thomas
Cock, Thomas F.
Collins, C. T.
Conant, D. S.
Cooke, John
Cooper, James S.
Corson, J. W.
Covel, John C.
Cox, Abm. L.
Crane, James
Crane, John J.
*Creveling, Abm.
Cullen, H. J.

Dalton, J. C, Jr.
Davis, E. H.
Davis, John
Delafield, Edward
Detmold, William
Douglas, J. Hancock
Douglas, Robert
Downs, Henry S.
Drake, Benjamin
Dudley, Wm. H.
Dwight, Wm. W.

Eadie, W. G.
*Earle, Edward
Earle, Pliny
Edgar, David A.
Edwards, Frank S.
Eliot, Ellsworth

NEW YORK ACADEMY OF MEDICINE.

77

Elliot, Augustus G.
Elliot, Fredk. W.
Elliot, Geo. T., Jr.
Elliott, James W.
Elliott, Thomas W.
Elder, Alexander
Ellis, Samuel C.
Emmet, Thomas Addis
Enos, Dewitt C.

Ferguson, John G.
*Ferris, Floyd T.
Ferris, Lynde C.
Fields, Edward
Finnell, T. C.
Fisher, George S.
Fisk. Lyman
Fitch, James D.
Forrester, James C.
Foster, Joel
Foster, S. Conant
Foy, Michael E.
Francis, John W.
Franklin, Edward C.
Franklin, Thomas M.

Gallagher, John
Gardner, Augustus K.
Garrish, John P.
Geer, Seth
Gescheidt, Anthony
Gilford, Jacob T.
Gilman, Chandler R.
Gibert, James T.
Goodrich, Charles S. J.
Gliick, Isidor
Gomez, Horatio
Gouley, J. W.
*Graham, John
Gray, H. M.
*Green, David
Green, Horace
*Greene, Isaac
Green, John W.
Gray, F. C.
Griscom, John H.
Guernsey, H.
Guernsey, Peter B.
Gunn, A. N.

Hall, Edwards
Hall, Samuel
*Halsted, J.
Halsted, Thad. M.
Harcourt, James

Hardenbrook, J. R.
Harris, Elisha
Harris, Stephen R.
Hart, John
Heard, John S.
Henriques, A. J.
Henschel, Charles
Hepburn, James C.
Herriot, George
Herzog, M.
Heywood, Charles F.
Hills, Samuel A.
Hintoh, J. H.
Hirsch, Simon
*Hobart, W. H.
*Hogan, Daniel M.
Hoit. Moore
Holcomb, Wm. F.
Horsfield, R. T.
Horsfield, T. W.
Hubbard, Samuel T.
Huntington, G. F.
*Hunter, Abraham T.
Husted, N. C.
Hutchison, J. C.
*Hutchinson, E. F.
Hyslop, George L.

Isaacs, Charles E.
Ives, George W.
Ives, John

Jackson, Wm. H.
Jackson, Francis H.
Jacobi, A.
Janes, E. H.
Jenkins, J. Foster
*Johnston, F. U.
Johnston, F. U., Jr.
Jones, E. Lee
Jones, Wm. W.
Jones, A. S.
Johnson, Wm. S.

Kammerer, J.
*Kearney, Ravaud
Keene, Stephen S.
Kennedy, James
Kilbourne, J. Sage
Kimbark, Everett H.
♦Kingsbury, G. H.
Kissam, Richard S.
Krackowitzer, E.
Kuypers, S. S.

78

OFFICERS, ETC., OF THE

Ladd, John G.
Learning, James R.
Lee, Charles A.
Lee, J. C.
Lee, Thomas D.
Leo- Wolf, George
Leo-Wolf, Morris
Leveridge, Benjamin C.
Levings, N. C.
Lewis, Geo.
Lewis, W. C.
Linsly, Jared
Livingston, W. C.
Ludlow, E. G.
Lyon, James L.

McCaffrey, Charles
McClelland, John
McCready, B. W.
McClaury, J.
McLeod, S. B. W.
*Macdonald, James
Macfarlan, Ebr.
*MacNeven, W. H.
Manley, James
*Manley, James R.
Markoe, Thomas M.
Martin, Joseph
*Marvin, David D.
Maxwell, W. H.
*Meikleham, D. S.
Metcalfe, John T.
Merritt, J. R.
Miller, Francis
Miller, John
*Miller, W. Ellison
Millett, Nicholas
Miner, William
Miner, William W.
Minor, James M.
Mitchell, Chauncey L.
Monell, J. A.
Moore, Edward
*Moore, S. W.
*Moran, Thomas
Morris, R. L.
Moses, Israel
Mott, Valentine
McNulty, John
Mullen, P. A.
Murray, Alexander

*Neilson, John
Nelson, James B.

Newcomb, George
Nichols, Elias S.
Nichols, Henry W.
Ogden, Benjamin
Ogden, John D.
Olmsted, Roger S.
O'Reilly, John
O'Rorke, James
Owen, J. Leech

Palmer, L. N.
Parker, E. H.
Parker, Willard
* Parkinson, W. B.
Paul, James C.
Peaslee, Edmund R.
Pennell, Richard
Pentz, Elias J.
Perry, Joseph S.
Peters, George A.
Phelps, James L.
*Phillips, S. B.
*Platt, Wm. F.
Pond, James 0.
Porter, Mortimer G.
Post, Alfred C.
Powers, T. W.
Power, William
Pratt, Peter
Priestley, John
Proudfoot, L.
Punnett, John
Purdy, Alfred S.
Purdy, S. A.
Purple, S. S.
Putnam, F. A.

Quintard, Charles T.

Randolph, Israel
Ranney, E. W.
Ranney, M. H.
Raphael, B.
Reese, David M.
Revere, F. B.
Richards, T. W.
Rising, J. C.
Roberts, Wm. C.

* Robeson, A. B.
Rockwell, William
*Rodgers, J. Kearny

* Rogers, J. Smyth
Ross, James
Rotton, Samuel

NEW YORK ACADEMY OF MEDICINE.

79

Sabine, Gustavus A.
Sayre, Lewis A.
Schilling, E.
Schirmer, William
Schmidt, J. W., Jr.
Seaman, Richard S.
Sewall, John G.
Shanks, John
* Sherwood, Burnt t
Sims, J. Marion
South worth, M. A.
Smith, Charles D.
Smith, Dfivid
*Smith, Gilbert
Smith, J. Lewis
Smith, Joseph M.
Smith, James 0.
Smith, Stephen
*Snowden, John
; Spring, Edward
Stearns, John
Stephens, James J.
Stephenson, Mark
Stevens, Alexander H.
Sterling, John W.
*Stickney, J. Dwight
Stewart, James
Stillman, J. D. B.
Stillwell, J. E.
Stewart, F. Campbell
Stimson, Edwin B.
Stone, John 0.
Storer, Ebenezer
Stout, Arthur B.
Strube, F.
Sweeny, Hugh
Sweeny, Owen
*Swett, John A.
Swift, H. S.

*Taft, Marcus L.
Taylor, Isaac E.
Tellkampf, Theodore A.
Thayer, Henry W.
Thomas, T. Gaillard
Thompson, A. G., Jr.
Tomes, Robert
*Townsend, Peter S.
Trudeau, James
Tucker, C. P.
Tuttle, John T.

Underhill, Alfred

Uhl, David

*Vache', Alexander F.
Van Arsdale, Henry
Van Arsdale^ Henry
Van Arsdale, Peter
*Van Buren, Thomas
Van Buren, P.
Van Buren, William H.
Vanderpool, Edward S.
Vandervoort, John L.
Van Hovenburgh, H.
Van Kleek, John R.
Van Pelt, M. D.
Van Rensselaer, Alex.
Van Roth, W.
Van Winkle, Ed. H.
Varick, Theodore R.
Vermilye, Wm. E.
Voss, L. H.

Wallace, W. W.
Walsh, Hugh
Warner, E B.
Warren, James
* Washington, James A.
Watson, John
Watson, Alex. T.
Watts, Robert
Weed, John W.
Weeks, Cyrus
Wells, Daniel
Wells, Ovid P.
Westervelt, John S.
White, Ambrose L.
White, Francis W.
White, Oliver
White, Samuel P.
Wight, L. L.
Wilhelm, H. N.
Wilkes, George
Williams, M. W
Wilson, William
Wood, Isaac
Wood, James R.
Wood, Stephen
Woodhull, H. B. W.
Woodward, George F.
Worster, Joseph
Wright, Aaron

Young, William.

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